MENTAL HEALTH: Capitol Shootings Accent Cracks In System

      Paranoid schizophrenic Russell Weston Jr.'s deadly rampage at the U.S. Capitol Friday could be a sign that the mental health care system in his home state of Montana -- and around the country -- is letting patients slip through the cracks. "I think the mental health system in general, not just in our state, has a problem with that linkage from when people leave inpatient treatment into community treatment in making sure that there's follow-up," said Randy Poulsen of the Montana Department of Public Health and Human Services (Murphy, Los Angeles Times, 7/27). Some say Friday's shooting could be the result of an "upheaval" in Montana's mental health care system. Since the state switched to a Medicaid managed care system a year and a half ago to care for the mentally ill, "both providers and patients have complained about poor service, long delays and slipshod payments," the AP/Billings Gazette reports (Laceky, 7/27). "We expected some start-up problems, but we didn't ... expect that it would go on this long," Poulsen said. "Certainly, I can't say that accessibility has improved, and I think maybe it has worsened."

Managed Care's Mistake?
      Cheaper medications that produce side effects are being prescribed under Montana's new system, and patients are wary of managed care treatment decisions. "I think that the psychiatrists and counselors are competent, and they know what's appropriate for the clients they're serving, and I don't really think that they need somebody standing over them who really doesn't know anything about it, telling them what services we need," said David Cockrell, a Missoula, MT, resident who is being treated for schizophrenia (Los Angeles Times, 7/27). But some Montana officials deny that improvements in the state's mental health system could have prevented Friday's shootings. "Frankly, there were other entities like the Secret Service who gave this individual a great deal of scrutiny but did not draw conclusions that would indicate somehow those here in the state of Montana may have missed something," said Gov. Marc Racicot (R) (AP/Billings Gazette, 7/27).

In The Headlines
      Newspapers across the country are examining the nation's mental health system in light of Friday's shootings:

• Baltimore Sun: "Schizophrenic D.C. Murder Suspect Reflects National Health Dilemma" -- Excerpt: "[W]hile new drugs can help some [schizophrenic] patients quiet their delusions and fears, gaps in our social and legal systems often allow them to abandon treatment and spiral into isolation, homelessness, drug abuse, violence and suicide" (Roylance, 7/28).
• Boston Globe: "Sharper Eye On Mentally Ill Urged" -- Excerpt: "[I]n the aftermath of two high-profile violent crimes connected to psychiatric patients, some state officials are renewing their call to close ... gaps in care -- urging, at the very least, medical checks on mental patients who have committed brutal crimes and been released later" (Kornblut, 7/28).
• Chicago Tribune: "Capitol Shootings Raising Debate On Mental Health" -- Excerpt: "The event ... focuses attention on what sort of laws can be instituted to better regulate the confounding issue of caring for mentally ill people who are capable of living in society but also capable of planning and carrying out a scheme such as Weston allegedly did" (Christian/Manier, 7/28).
• New York Times: "Treatment Can Be Illusion For Violent Mentally Ill" -- Excerpt: "[Weston's] history of mental illness has much in common with other delusional mentally ill people who become violent, illustrating both the cracks in the nation's mental health system and its difficulty in compelling treatment, even for those at risk of becoming violent" (Butterfield, 7/28).
• AP/Philadelphia Inquirer: "Experts Say It's Hard To Keep Schizophrenics On Medication" -- Excerpt: "About half of all schizophrenics quit their medications and experience a relapse of symptoms within a year of treatment, studies show ... Compounding the problem, doctors say, is an overburdened health care system that haphazardly tracks potentially dangerous patients after they have been discharged from inpatient facilities" (Verrengia, 7/28).